Judith A. Lyons

Keane PTSD Scale: MMPI and MMPI-2 Update

This paper addresses questions regarding the use and interpretation of the Keane MMPI PTSD scale. Particular focus is placed on issues to consider when using various versions of the MMPI including Form R, the group form, and the new MMPI-2.

Single-voxel proton MR spectroscopy of right versus left hippocampi in PTSD

Previous magnetic resonance (MR) volume imaging and proton MR spectroscopy studies have suggested a reduction in the hippocampal size and/or neuronal/axonal density in posttraumatic stress disorder (PTSD). The lack of agreement on the laterality of the hippocampal dysfunction prompted this study. A total of 20 veterans (18 men and two women) and one female non-veteran participated in this study conducted in accordance with approved human study protocols. Six of the male veterans and the female non-veteran were without PTSD. Vietnam veterans formed a large subset of the study subjects. Single-voxel proton MR spectra were obtained from the hippocampal region bilaterally on a clinical MR scanner operating at 1.5 T. Analysis of the proton MR spectra showed a decrease in hippocampal NAA/creatine ratio in PTSD subjects significantly higher on the left than the right for the entire study group, as well as for the Vietnam subset. It was concluded that the hippocampal dysfunction in PTSD is lateralized with the left side being more impaired than the right.

Behavioral treatment of a motor vehicle accident survivor: An illustrative case of direct therapeutic exposure*

Direct therapeutic exposure (DTE) is one of a class of exposure-based treatment techniques that includes in vivo and imaginal flooding, and implosive therapy. DTE is a recommended technique for the treatment of persons experiencing distress as a result of exposure to traumatic events (e.g., accidents, combat, sexual assault). However, the process of applying DTE has not been sufficiently documented so that it can be applied by practicing clinicians. Through the use of an illustrative case example of a motor vehicle accident survivor, the authors strive to clarify the manner in which DTE is implemented. In doing so, an attempt is made to set aside many of the misunderstandings regarding DTE that have led in the past to improper (and thus unsuccessful) application, or to avoidance of DTE. As the case study highlights, however, DTE by itself may not be sufficient, and when it is not, it should be coordinated with other treatment modalities to maximize and maintain treatment gains.

The Keane PTSD Scale extracted from the MMPI: Sensitivity and specificity with Vietnam veterans

A study was conducted to further investigate whether the Keane Posttraumatic Stress Disorder (PTSD) Scale of the Minnesota Multiphasic Personality Inventory (MMPI) can be employed as a separate instrument administered outside the context of the full MMPI. A group of Vietnam combat veterans with diagnosed PTSD and two comparison groups of veterans without PTSD (Vietnam combat and era veterans) were diagnosed by clinical interviews. Over 84% of the 64 veterans in the study were accurately classified by the Keane PTSD Scale into their original diagnostic groups. Excellent test sensitivity was demonstrated, with 90% of combat veterans with PTSD being properly classified by the Keane PTSD Scale when the recommended cutoff score of 30 was utilized. The clinical and research implications are discussed.

Brief Cognition-Focused Group Therapy for Depressive Symptoms in Chronic Posttraumatic Stress Disorder: A Pilot Study

ABSTRACT A growing literature supports the inclusion of cognitive therapy components in the treatment of posttraumatic stress disorder (PTSD) and, in many cases, concomitant depression. However, further research is needed to examine whether cognitive therapies may serve as an effective approach to emotional regulation in cases of chronic treatment-resistant PTSD (e.g., combat veterans who have been in treatment for 20 or more years). This article outlines a brief outpatient cognitive emotion-management group with a present focus. The intervention, based on cognitive appraisal theory, is designed to reduce negative cognitive appraisals and depressive symptoms among individuals with treatment-resistant PTSD. Participants were 21 men and women (4 male cohorts and 1 female cohort) in a VA treatment program for trauma-related distress who met screening criteria for high depressive symptoms and evidenced maladaptive cognitive appraisals of stress. For 14 participants with complete data, the treatment yielded partial improvement in cognitive appraisals and improvement in depressive symptoms. Although conclusions are tempered by the absence of a control group and the small sample, these findings provide preliminary support for the treatment protocol.

Patients' Attitudes Toward a Therapeutic Writing Group for Veterans with PTSD

Abstract Writing about stressors has helped many nonclinical groups, but implementation with clinical groups has been less consistently successful. The introduction of a written exposure therapy component into an existing residential PTSD treatment program is described. Facilitative strategies and obstacles are discussed. Initial receptivity varied widely across patients, ranging from interested engagement to refusal. Protocol adjustments were followed by increased acceptance. Patient ratings of the value of the intervention increased from pre — to post-treatment. Perceived intervention value was unrelated to education, PTSD severity, concerns about writing, and prior writing experience, but was correlated with intent to continue writing in the future.

Increased Resilience is Associated with Positive Treatment Outcomes for Veterans with Comorbid PTSD and Substance Use Disorders

ABSTRACT Objective: Resilience has been associated with less severe psychiatric symptomatology and better treatment outcomes among individuals with posttraumatic stress disorder (PTSD) and substance use disorders. However, it remains unknown whether resilience increases during psychotherapy within the comorbid PTSD and substance use disorder population with unique features of dual diagnosis, including trauma cue-related cravings. We tested whether veterans seeking psychotherapy for comorbid PTSD and substance use disorder reported increased resilience from pre- to posttreatment. We also tested whether increased resilience was associated with greater decreases in posttreatment PTSD and substance use disorder symptoms. Methods: Participants were 29 male veterans (Mage = 49.07 years, SD = 11.24 years) receiving six-week residential day treatment including cognitive processing therapy for PTSD and cognitive behavioral therapy for substance use disorder. Resilience, PTSD symptoms, and trauma cue-related cravings were assessed at pre- and posttreatment. Results: Veterans reported a large, significant increase in resilience posttreatment (Mdiff = 14.24, t = −4.22, p < .001, d = 0.74). Greater increases in resilience were significantly associated with fewer PTSD symptoms (β = −0.37, p = .049, sr = −.36) and trauma-cued cravings (β = −0.39, p = .006, sr = −.38) posttreatment when controlling for pretreatment scores and baseline depressive symptoms. Conclusions: Results suggest that evidence-based psychotherapy for comorbid PTSD and substance use disorder may facilitate strength-based psychological growth, which may further promote sustained recovery.

Issues in conducting exposure therapy to treat combat veterans' PTSD

Publisher Summary Each war era brings with it unique nuances and social contexts that shape traumatic events, the way individuals perceive those events, and the availability of supportive social networks after such events. Individual dispositional factors add further variability. Most of the points stated throughout this chapter are based on clinical observations with veterans in the United States. It is reasonable to expect that the aforementioned factors may not influence posttraumatic stress disorder (PTSD) symptom presentations similarly across different cultural and demographic groups. Further, as combat technologies continue to develop and new war theaters continue to emerge, it is expected that there will be new discoveries about the development, maintenance, and treatment of combat-related PTSD. Research into the etiology and treatment of PTSD represents a body of knowledge that can reasonably be expected to evolve as the role and structure of the military continues to be redefined.